Does Every Intoxicated Patient Need IV Fluids?

ABSTRACT & COMMENTARY

Source: Li J, et al. Intravenous saline has no effect on blood ethanol clearance. J Emerg Med 1999;17:1-5.

Intravenous (iv) fluid therapy is commonly used by emergency physicians in the treatment of adult patients with acute alcohol intoxication. The proposed rationale for this therapy is that it hastens the time to sobriety by increasing the clearance of ethanol. Li and colleagues sought to test this hypothesis in 10 healthy volunteers (5 men and 5 women, ages 23-36 years) by using a crossover study design where subjects served as their own controls. During the first phase of the study, subjects were given 0.81 g/kg of ethanol orally (calculated to result in a target blood alcohol level of 150 mg/dL). Breath alcohol readings were obtained prior to ethanol administration, and every 20 minutes thereafter for up to six hours. Four days later, the same procedure was followed, except that subjects were administered 1 L of normal saline at a wide open rate immediately following the administration of ethanol.

Linear regression analysis revealed no difference between the ethanol clearance of the two groups (16 mg/dL/h and 15 mg/dL/h for the control and IV groups, respectively). Li et al conclude that IV fluid therapy does not accelerate physiologic clearance of ethanol.

Comment by Frederic Kauffman, MD, FACEP

I enjoy simple studies addressing clinical dogma poorly founded in the medical literature. This study is one such attempt to look at a common practice to determine if indeed it makes sense. There certainly are limitations to this study, and its results only can be applied to otherwise healthy and young patients who present intoxicated and with no other clinical problems. I would not assert, based on this study, that an intoxicated chronic alcoholic with a multitude of related medical problems (such as malnutrition, electrolyte disturbances, liver disease, portal hypertension, etc.) should not have an IV placed in the ED. I would, however, emphasize to my students and residents that IV fluids likely do not enhance ethanol clearance, and that the "need" for IV fluids should not be a knee jerk response in every patient who is intoxicated and needs a place to "sleep it off."